Claim total
$504.69
base $93.39 · payer covered $454.69
The visit
- Class
- Ambulatory
- Code
- 185345009
- Reason
- diagnosis concept Childhood asthma233678006
- Start
- 1959-05-24
- Stop
- 1959-05-24
The parties
- Patient
- patient Dione Anissa Jaskolski
- Provider
- provider Lawrence Lemke
- Care site
- care site FAIRVIEW HEALTH SERVICES
- Payer
- payer Medicaid
Record id
24b7c6b0-4eef-ea68-b199-12b2cf1add78